Management of violence in the workplace: a New Zealand survey.

OBJECTIVE: To estimate the rate of adverse events to staff, to survey the use of various preventative measures, and to assess any association between these factors and the reported event rate. METHOD: An anonymous postal nation-wide survey of violence reported to managers of psychiatric units in New Zealand. RESULTS: The mean rate of adverse event per 100 full time equivalent staff was 16.2 (range 0-187) for property damage, 16.3 (range 0-204) for attempted assault, 12 (range 0-194) for physical attack, 1.3 (range 0-33) for sexual harassment and 1.1 (range 0-17) for stalking. Inpatient units, the use of pocket alarms, and training in de-escalation were associated highly with an increase risk of adverse events. CONCLUSION: There is a high variation in the rate of violence. The issue of increased rate of events with certain interventions will require further research.

Problem drinking profiles of patients presenting to general practitioners: analysis of Alcohol Use Disorders Identification Test (AUDIT) scores for the Auckland area.

AIM: To quantify the prevalence and demography of at-risk and problematic drinkers in the population attending a random selection of general practices and to compare this with similar studies. METHOD: A study examining the uptake and utilisation of the "DRINKLESS" package to 369 New Zealand general practitioners was conducted during 1995/6. The "DRINKLESS" package was developed with the World Health Organisation collaborative study for brief intervention for at-risk alcohol consumption. The package uses the Alcohol Use Disorders Identification Test (AUDIT). There were 15,670 completed AUDIT questionnaires collected during the study. These were analysed to ascertain the prevalence and demography of at-risk and problematic drinkers attending general practitioners. RESULTS: There were 16% of patients identified as having either "risky drinking" or "problematic or dependent drinking". This pattern varied according to the occupation, age and gender of patients. CONCLUSIONS: The data confirm that large numbers of patients presenting to general practitioners experience alcohol problems of varying degrees. This study also suggests that the AUDIT will have satisfactory detection rates in a primary care setting.

Incentives for general practitioners to provide brief interventions for alcohol problems.

AIMS: To assess current practices and attitudes of general practitioners towards prevention and intervention with problem drinkers. METHODS: GPs randomly selected in the Central and Southern Health Regions answered a 134 item questionnaire on their involvement with patients with alcohol related problems. RESULTS: In all, 136 general practitioners responded representing 85% of those approached. When asked how often they provided interventions with alcohol problems, 86% reported managing under 13 patients per year, indicating an intervention rate of less than 1% of the mean practice size. In terms of disease prevention, 86% rated 'drinking moderately' as important but this endorsement ranked fifth behind other lifestyle behaviours such as 'not smoking' at 99%. When asked about their perceived role, they indicated higher role legitimacy but lower work satisfaction with alcohol problems. In terms of training, three-quarters stated they had received less than eleven hours of postgraduate alcohol education. They also rated their current effectiveness with alcohol problems as substantially less than potential effectiveness. They indicated the main obstacles to be: government funding policies, lack of adequate training and a need for improved resources and support services. CONCLUSIONS: With research having established the effectiveness of interventions for harmful alcohol consumption, attention has shifted to ways of engaging general practitioners in providing interventions. This study highlighted how changes to government health policy and improved competency and skilled based training could lead to a greater acceptance by general practitioners of the role they could play in reducing alcohol related problems.